Provider Demographics
NPI:1922035070
Name:SYMONDS, JOHN T (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:SYMONDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-2655
Mailing Address - Country:US
Mailing Address - Phone:660-562-2600
Mailing Address - Fax:660-562-7911
Practice Address - Street 1:2016 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2655
Practice Address - Country:US
Practice Address - Phone:660-562-7099
Practice Address - Fax:660-562-7999
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77208D00000X
MO2007010486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
080017219OtherPALMETTO GBA RR MEDICARE
NE07049OtherBLUE CROSS BLUE SHIELD NE
NE07049OtherBLUE CROSS BLUE SHIELD NE
E96962Medicare UPIN